Asthma study reveals the power of the placebo effect

Basi · #1 by **Basi** » Jul 19, 2011 3:53 pm

Asthma study reveals the power of the placebo effect

The placebo effect is alive and well, at least for patients with acute asthma.

That’s the finding of a pilot study funded by the National Center for Complementary and Alternative Medicine -- part of the National Institutes of Health -- and published in Thursday’s edition of the New England Journal of Medicine.

Researchers from Harvard Medical School and colleagues decided to test the placebo effect in asthma patients because it’s easy to assess their physical improvement (as measured by lung function tests) in a short period of time.

They recruited 39 patients who cycled among four treatment options over 12 visits. In some cases they got albuterol -- a bona fide asthma treatment -- through an inhaler, and sometimes they used an inhaler with no medicine, though the subjects didn’t know which was which. Other times, they were given sham acupuncture treatment (but told it was real), and on some visits there was no treatment at all.

Patients said their symptoms improved by 21% on the occasions when they got no treatment. But when they thought they were getting some kind of treatment, they said their symptoms improved much more -- by 50% when they got the albuterol, by 45% when they had the placebo inhaler, and by 46% with the sham acupuncture. (There was no statistically significant difference among those three outcomes.)

Did they really get that much better? When they had the albuterol, patients’ maximum forced expiratory volume in 1 second (a measure of lung function) improved by 20%. But in all three other cases, lung function improved by only 7.1% to 7.5%.

The results demonstrate that the placebo effect is powerful, the researchers said. When it came to patients’ assessments of the treatments, “the placebo effects were equivalent to the drug effect,” they wrote.

These results also suggest that patients can’t be relied upon to make accurate reports of whether their symptoms are getting better. In this study, patients couldn’t tell when the albuterol was making a real difference. In fact, any time they got something that looked like a “treatment,” they reported roughly the same degree of improvement, the researchers said.

“Even though there was a large, objective drug effect ... that was nearly three times the effect of the two placebos and the no-intervention control ,” they wrote, “patients could not reliably detect the difference between this robust effect of the active drug and the effects of inhaled placebo and sham acupuncture.”

http://articles.latimes.com/2011/jul/13 ... t-20110713

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Thoughts of the general RatSkep-er on placebos?

Animavore · #2 by **Animavore** » Jul 19, 2011 3:59 pm

That is interesting. It is an odd effect. I've noticed myself that sometimes the lung burning sensation goes away when I just put the inhaler to my mouth.

Richard Friedel · #3 by **Richard Friedel** » Jul 21, 2011 6:59 am

As can be seen from „Asthma The Biography“ by Mark Jackson of Exeter University England (on Google Books), the disease has meant the fateful and almost true believer quest for a causally acting medication This meant neglect of respiratory mechanisms for increasing the asthma-impaired lung inflation.

As recently demonstrated by Prof. Alison McConnell in England and Dr. Paltiel Weiner in Israel and many other scientists, inspiratory resistance is needed for adequate lung function. This might seem obvious owing to the association between asthma and mouth breathing (involving the absence of resistance on an inhale). The method recommended for combating asthma has been named “respiratory muscle training”, but Weiner states (http://chestjournal.chestpubs.org/conte ... 7.full.pdf)

“The main mechanism whereby hyperinflation adversely affects the inspiratory muscles is by forcing them to operate in an inefficient part of their force length relationship. Hyperinflation shortens the inspiratory muscles and diminishes their ability to generate negative pressure while inspiring It causes the flattening of the diaphragm, which in turn places it in a serious mechanical disadvantage, because it has to be curved upwards (according to Laplace's law) in order to be effective.
The axial direction of the diaphragmatic fibers is also lost by
hyperinflation.
They are directed medially or inward and have mainly expiratory action. The area of apposition between the costal fibers of the diaphragm and the inner rib cage becomes smaller, resulting in less effective rib cage expansion during inspiration.”

So the method might be pedantically termed “inspiratory muscle alignment training”. The devices such as “Powerbreathe” are calibrated so as to know what suction is being applied.

However a rough notion of the mechanism may be obtained by drawing in air through a stenosis defined by finger placed between one’s lips which perhaps a bit more natural than a device. It has the advantage of being able to increase suction toward the end of each inhale, but the experts recommend a device.

All this goes to show that classical approaches to asthma may be a waste of time. RF

zulumoose · #4 by **zulumoose** » Jul 21, 2011 9:01 am

There are 3 stages to asthma progression.

First there is inflammation of the passages

Then there is spasm in the surrounding muscle tissue

Then there is mucous production within the narrowed passages.

The inhaler they used treats only the muscle spasm, by relaxing the muscle fibres, and thus has only a short term and limited effect. Relaxation on a bench for sham acupuncture treatment would likely have a similar calming effect, by reducing the urgency of breathing and thus the incidence of spasm.

I cannot see how this has anything to do with the proper management of asthma which prevents the first stage of an attack, the inflammation of the passages.

Inflamed passages are inflamed passages, placebo effect of calming would have little or no impact on the test results obtained, you can only breathe so well through inflamed passages.

levesqueiroq · #5 by **levesqueiroq** » Jul 21, 2011 10:23 am

fascinating

has everyone read 'bad science'? a cracking book looking at the placebo effect

i was interested in buyong some 'allergy reliever' which was basically a two pronged gadget you shove up your nose and its meant to kind of numb the nasel passages sensitivity to your allergies.

i cant find out from anywhere (other than anecdotal) whether it works. and im not sure with my skeptical mind whether it would work if i dont really believe in it

zulumoose · #6 by **zulumoose** » Jul 21, 2011 10:40 am

Rule of thumb:- If all the stated support for a treatment is anecdotal - it is very unlikely to be anything other than placebo quackery.

If they had good studies to support their claims, why would they hesitate to reference them?

Weaver · #7 by **Weaver** » Jul 21, 2011 12:46 pm

Very good commentary on the quite poor conclusions drawn by the authors of this study:

http://scienceblogs.com/insolence/2011/ ... asthma.php

zulumoose · #8 by **zulumoose** » Jul 21, 2011 1:31 pm

Had a look at that Weaver, yes absolutely.

Reading the OP again, it seems the main drive of the LA Times article is to show that patients cannot be relied upon to self-report effects, ie evaluate themselves and their symptoms.

People are very quick to believe intervention helps, any intervention. No wonder quackery has a long and profitable history.

Animavore · #9 by **Animavore** » Jul 21, 2011 2:09 pm

When I was a child I used to suffer constant headaches. Every other day I would be asking my mother for an Anadin. I remember one day I was about 11 and I noticed that no sooner had I taken the pill my headache was gone. I knew this couldn't be right because the TV ad said, in the small print, to allow 20 mins. I decided to test it the next time and my headache was starting to disappear even as I was going down to my ma to ask for a tablet. I decided it was in my head. I've never had a headache since even to this day.
I wouldn't have known it then but I think I placeboed myself. I think this what happens with the laying of hands and calling to Jesus to remove back pain (in cases where it works) and it goes for years or ever. Clearly it doesn't need a God. Just a belief.
Now my case may not be placebo at all. Just coincidence. Seeing as learning about placebo hasn't un-placeboed me.

Darwinsbulldog · **#10** by **Darwinsbulldog** » Jul 21, 2011 4:36 pm

There is nowt really new in the study...it has been known for a long time that placebo works for some conditions but not others. You have lost your leg, but you take a sugar pill, believing that it will make your leg re-grow. No matter how much you believe that pill will make your leg grow back, it won't.

Placebos are effective for some conditions where the mental state does effect the outcome, but it is unethical as it Involves deceit to work. That is why Docs don't use it any more and why Homeopaths etc can claim victories for some conditions, because they do use that deceit.
This is why drug trials are double-blind studies where the docs and the patients don't know if they are taking Drug A, drug B or the control [placebo]. it is to measure there effect of the new drug vs the old, not drugs vs placebos. So even if the study data and conclusion are valid, it does not matter.
If Docs did start to deceive their patients, then trust will go down and patients will not take medication in cases where the placebo effect makes no difference. A really dumb idea. It can't be used- they have to find another way.

levesqueiroq · **#11** by **levesqueiroq** » Jul 22, 2011 8:10 am

Animavore wrote:When I was a child I used to suffer constant headaches. Every other day I would be asking my mother for an Anadin. I remember one day I was about 11 and I noticed that no sooner had I taken the pill my headache was gone. I knew this couldn't be right because the TV ad said, in the small print, to allow 20 mins. I decided to test it the next time and my headache was starting to disappear even as I was going down to my ma to ask for a tablet. I decided it was in my head. I've never had a headache since even to this day.
I wouldn't have known it then but I think I placeboed myself. I think this what happens with the laying of hands and calling to Jesus to remove back pain (in cases where it works) and it goes for years or ever. Clearly it doesn't need a God. Just a belief.
Now my case may not be placebo at all. Just coincidence. Seeing as learning about placebo hasn't un-placeboed me.

did you watch "Derren Browns, Miracle for sale"?

he took some average chump and turned him into a faith healer and fooled a load of people by using all the tricks derren worked out for himself. it was brilliant

the 'hand touching' you mention above was one he used on some street healing he did, getting someone with a bad leg to held the leg out (uncomfortable) and then touch the leg and then tell the person to put their leg back on the floor (leg feels relaxed and no longer uncomfortable) and hey presto, youve been healed by gods holy spirit... :pray:

Animavore · **#12** by **Animavore** » Jul 22, 2011 8:23 am

Maybe they can cure chairman who has been affected by a bald patch?

Actually that Derren Brown one is the only one I haven't seen. I must look it up.

Richard Friedel · **#13** by **Richard Friedel** » Oct 10, 2011 9:15 am

As I attempted to point out in my first posting here current asthma treatment relies on a popular fallacy.
1) Lack of utility – it leads to more asthma, http://www.moh.govt.nz/notebook/nbbooks ... asthma.pdf see page 7.
2) Scientific rebuttal of basic hypothesis: contrary to medical opinion besides the effect of asthma on breathing, breathing affects asthma – research on inspiratory muscle training (IMT) which has a curative or at least a substantial symptomatic effect ostensibly free of side effects.
3) This research shows that training the inspiratory muscles is effective. Logically speaking reducing load on them artificially medically would weaken them and worsen asthma. The medical assumption that asthma is only inflammation and that muscle deconditioning could not be relevant is disproved. The question of this type of rebound as with nose drops or laxatives should be examined.
4) The experience made with the once so medically popular blood letting should demonstrate the danger of an eternal return or reoccurrence of the same. RF.

Richard Friedel · **#14** by **Richard Friedel** » Jan 03, 2012 3:31 pm

The mention of asthma as a purportedly scientifically understood and treated disease shows the reliance on a many angels on the head of a pin type of argument here, betraying the aims of the authors. The extensive scientific writings on inspiratory muscle training and the widespread use of the respective appliances clearly indicate not only that asthma symptoms may be eliminated by such training but also that the muscle detraining effects of asthma drugs must be responsible for the epidemic. Furthermore all too relevant is the utter absence of the least serious enquiry about causation due to treatment. Obviously anyone afflicted by the disorder should consult a physician aware of the developments. RF

Weaver · **#15** by **Weaver** » Jan 03, 2012 7:06 pm

"Causation due to treatment"?

The treatment for asthma symptoms causes the asthma reaction which generates the symptoms which are treated? Seriously?

Richard Friedel · **#16** by **Richard Friedel** » Jan 05, 2012 8:43 am

Glad to see Emo Phillips is being cited. The thread is surrealistic. If training inspiratory muscles abates asthma symptoms as a back to nature approach, then relaxing the opposing constricted airway muscles by drugs will stop any natural training and tend to decrease physiological adaptation. The steady increase in asthma morbidity has an obvious cause. RF. Over!

pauli2k · **#17** by **pauli2k** » Jan 08, 2012 7:46 am

Weaver wrote:"Causation due to treatment"?

The treatment for asthma symptoms causes the asthma reaction which generates the symptoms which are treated? Seriously?

Wow! Just hearing that for the first time.

matt8819 · **#18** by **matt8819** » Jan 08, 2012 8:13 am

Richard Friedel wrote:Glad to see Emo Phillips is being cited. The thread is surrealistic. If training inspiratory muscles abates asthma symptoms as a back to nature approach, then relaxing the opposing constricted airway muscles by drugs will stop any natural training and tend to decrease physiological adaptation. The steady increase in asthma morbidity has an obvious cause. RF. Over!

This thread was also dead for months till you posted. Is this thread the only reason you joined the forum?

Richard Friedel · **#19** by **Richard Friedel** » Jan 09, 2012 9:56 am

To matt8819

Better late than never. Go figure. RF

Richard Friedel · **#20** by **Richard Friedel** » Jan 15, 2012 8:28 am

A further strong theoretical argument in favor of IMT (and showing the inapropriateness of asthma drugs) is provided by research of Dr. Gwen Skoot
“Our laboratory focuses on clinical asthma studies. We hypothesize that hyperresponsiveness is caused by impairment in the ability of inspiration to stretch airway smooth muscle (ASM) -- i.e. impaired bronchodilation. This hypothesis is supported by our finding that sensitivity to the constrictor agent Methacholine is the same in normals and asthmatics when challenge is conducted without deep breaths. It is also known that deep inspiration (DI) prior to a constrictor agent is bronchoprotective in normal subjects. We have shown that this effect relates to inspiratory velocity, i.e. a fast DI is more bronchoprotective than a slow DI. We speculate that in healthy subjects, DI stretches ASM and breaks cross bridges and that cross bridge breakage is enhanced with increased inspiratory velocity. In asthmatics, inflammation may impair this ability. Further protocols will focus on the mechanism of the impaired response to DI in asthma in order to ultimately develop interventions to treat this aspect of hyperresponsiveness. “http://www.mountsinaifpa.org/profiles/gwen-s-skloot

QED : the study on which the thread is based is ivory tower thinking. RF.